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CITY OF CUPERTINO
,3,
BUILDING DIVISION PERMIT
CU CRACTQit "I ,
,
BUILDING ADDRESS:
PERMIT N00 3 0 6 0 0 8 9
OWNER'S NAME:
PERMIT I$UWD 11 / 2 0 0 3
/ 1
INE:
SANITARY NO. CONTROL NO.
ARCI fW ECF/ENGINEER:
BUILDING PERMIT INFO
BIRO ELECT PLUMB MECH
LICENSED CONTRACTOR's DECLARATION
lob Description
1 bereby affirm Nal I sm licensW under provisions of Chapter 9 (commencing
P
wild S.ti,n7M),f Division 3 of the Business and Professions Code, and my licammu
Liicense0.nd errant.
j� ��.,„II pq �t(I gy��
REROOF LrM
Uc.g
� 1r�DU�'Ilr�'
Dam Cnnlraemr
CONTRACTOR: BETA CONSTRUCTION
ARCHITECTS DECLARATION
1 understand my plana NN W used as public records,
l G 1 2 2003
AUG
F1 V lTfcssi...
Licensed PmI
OWNER-BUILDER DECLARATION
I thereby .from Nal 1 am attempt Imre the Consmmors umnse Law for the
�' I` �� NI�' GP_
following muon.(Section 7031.5, Business and Pofessiom Code: Any city or county
which requires a permit to cnnswn, altar, Improve, demolish, ,r repair any structure
prior to its iuua.e. also inquires the applicant for such permil On file a signed statement
that he is licensed pursuant to the provisions of the Comracmri Uease Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 71)(p) of Division 3 of the Business and Professions Code) or
$3800
th•t he is eumpt therefrom and dm bub for the alleged exemption. Any violation ,f
APN Number
Occupancy Type
P y yp
Section 7031.5 by any applicants for a Permit ubjects the applicant o a civil penalty of
not more than five hundred dollen (5500).
37531028 00
❑I,uowneroftWpmpmry.amyemploymswi0mwuthci,.iocompenution.
Required Inspections
will do the work and she mmaure is not Intended oroffemd for W. (Sec. 7044, Business
Code: The Cmumetora License Law does
and Profesm.m, not apply In an owner of
305 - FRAME
property who buildsor improve bercon, and who dommch work himselforthrough hitt
own employers, provided thus.h improvements are not lntanded mufferad for sale. If,
307 — INSULATION
however, the buildlog or Improvement is veld within one you of completion, the owner.
builder will have the burden of posing that W did tat Wild or improve for purpose of
601 - . ROOF TEAR OFF
sale')'
602 - ROOF PLYWOOD NAIL
0 1. as owner of the property, am "elusively contracting with licensed commacmn in
603
construct the pmject(Sm. 704a, Business and Professions Code:) The Conuacmes LI.
— ROOF BATTENS
cone law does not apply m an owner of property who Wilda or improves thereon.and,
604 — ROOF IN -PROGRESS
who contracts for such projects with acommmur(s) licensed pursuant m the Contranors
'
License Law.
❑ lunemmptunders.. .BkPCf I recon
Dam I
—rRIKFS COMPENSATION DEC N
I Wreby, afttrm under penally of perjury am of the following dedmilmu:
-
I have and will maintain• C.rdficam of Consent m self.lnsure for Worker. Compen.
cation, u provided for by Section 3700 of the IOW, Code, for she performa.e of the
work for which this permit is WOOL
1`1'1 Wve and will maintain Workers Compensation luuranm, u required by Section
3700,f the laWrCode, for the performance of the work for which this permit i. Issued.
My W,rkeea CompensW on Insuran¢ canim and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W complead Iftlhe Permit is froom hundreddollen (SIM)
or kis)
I certify Nat in the perfo..... f the work for which Nis permit is issued, I shall nm
employ anyperson in any manners, u to become Wb' im'h�Wgrkeri Compeuatlon
Law . lifom'.Dam as
'
yo-fC Tf��[
NorAPPLICA : if, after making this Cenita of Exemption, you gla uta
IC
been subject m the Worker's Compensation previsions of the Labor Code, you most
fo"with comply with such provisions or this permit stall W desmed m,ked.
CONSTRUCTION LENDING AGENCY
I thereby affirm that them is, consWction lending agency rot the porformance of
the work fur which this permit N issued (See. 3097, Civ. C.)
Lenders Nunc
Lender'. Add.
1 comfy that I have mad this application and sate that the aWve Information is
'
couccl. I agree m comply with all city and county ordinances and sate laws relating to
building convection, and hereby authorle, repremnadves of this city to enter upon the
above-mentioned property for inspccli,n purpose&
(We) S. to save, indemnify and keep harmless the City of Cupertino against
Iiebilitiu,judgments, eman
u and emenses which may In y way accmc against aid City
in consequence of the granting of this permit.
♦A
6
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT
Issued by: Da
RCE REgULATIONS, --%—,?
V
Re -roofs
Type of Roof
`7G� C II
Signature of IlcanuCon car Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant more or handle husrdous material
a defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
otic. Section 25532(.)7
All roofs shall be inspected to any roofing material being installed.
Yes �JJo
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building nccupam use equipment or devices which
it hanNnns air contaminants u defined by the Bay Area Air Quality Mangcmcnt
all new materials for Inspection.
istna7
O Yes QNu
Ihave mal Ne hvaAtuamamriels mtryiroments under Chapter 6.95,fted Cali(or.
niceRealm@Safety Cc ,S.domx5505.x553) mu1x553a.Iundemmtd lhaiflW Wilding
/f n
yam,. h
does not currently have a arnanl the, it b my responsibility m h
4 –ll�� A "�(^v ��' V
(
redly occupant or the
vimmcmr It hm"m nu,Ipnmmimmn.e.f.CcniIIm of cc cY
Signature o Applicant Date
—�G. �t� l / i, )a
All roof coverings to be Class "B'� or better
owners j"tr,a
ath,rircdage
�CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408)777-3333
Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re -roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re -roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre -inspection and/or tear off approval.
2) In -progress inspection approval.
. 3) Final inspection approval.
a) Spark arrester installation.
5. , If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of Y4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name: �A�✓ GiPnUl2f/OW�
Job Site Address: r 9 ,5- C rkw C b fh A" nn tra-
Roofing Company Name: erin ON 5
ipAlicant'eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date:
151(LIO,
G
CITY40
CUPERTINO
CITY OF CUPERTINO 3 0 �o k%
REROOF /
PERMIT APPLICATION FORM
APN #
„
Date:
Building Address:
Energy
BUILDING
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
Seismic Commercial
A Cl P A LC -.f,
BPLANCHK
Contractor: 3;s71->9-
6. A) SgaPhone #:
License #:
Business License
i/i� Z 1S PIJ
o Z �'
Contact:
Phone #: Cupertino Business License #:
a
bas - l -C 61 T
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
'g Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑. Wood Shingles , / [7'—
X Other (Specify) COM s1` 1V451 S -
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Descriptio
X
Residential
Commercial ❑
Fire Zone: Yes ❑ No
❑ Confirmed with Planning De t. if
there are any restricts s-.
Cost o oe t:
Type of Construc4io Occupancy grou .
_
Qty. if
AnnlAable
Fee ID
Fee De.-nrintinn
Frr.f;rnnn
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING